Making Good Better: Implementing a Standardized Handoff in Pediatric Transport

Weingart, Caroline; Herstich, Tracey; Baker, Pam; Garrett, M. Lynne; Bird, Mike; Billock, James; Schwartz, Hamilton P.; Bigham, Michael T.

doi:10.1016/j.amj.2012.06.005

Cited by 41 publications

(19 citation statements)

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“…This approach is currently being rolled out for epilepsy care in the UK in the form of the Epilepsy Passport. In the context of telephone assessments, adherence to safety netting protocols could be improved through the use of mnemonics or checklists [95–98]. …”

Section: Discussionmentioning

confidence: 99%

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

et al. 2017

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BackgroundThe UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting.Methods and FindingsWe undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions.Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods.ConclusionsThis study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.

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Section: Discussionmentioning

confidence: 99%

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

et al. 2017

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“…25 The patient's physician, whether a physician on duty, a hired physician or a physician assistant, must transfer requests to the SAMU Regulatory Center. 18 They are responsible for providing correct information about the clinical condition of the newborn during the telephone call, which are important to establish a priority in care.…”

Section: Discussionmentioning

confidence: 99%

“…25 In order to provide care to critically ill patients, the communicative process should be used as a continuous tool to provide security and clarity to professionals because they deal with stressful situations that require careful attention and perfect understanding of the information transmitted.…”

Section: Discussionmentioning

confidence: 99%

Dificuldades No Transporte Inter-Hospitalar De Recém-Nascido Crítico Realizado Pelas Equipes Do Serviço De Atendimento Móvel De Urgência

Balbino

Cardoso

2017

Texto contexto - enferm.

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Objective: to investigate the difficulties of the Emergency Mobile Care Service teams to interhospital transport critical newborn in an ambulance.Method: this is a qualitative study carried out with 17 healthcare professionals, as physicians, nurses and drivers of vehicles working in the Emergency Mobile Care Service of a municipality in the interior of Ceará, from November to December 2014. Semi-structured, recorded interview produced the data, which we analyzed through thematic content analysis.Results: the categories we gathered were shortage of materials, equipment and vehicles exclusive to interhospital transport; knowledge, deficient practice and training to assist critical newborns; and failure to communicate among professionals and difficulty in ambulance mobility on public roads. Conclusion:these difficulties connect to all levels of management and require a differentiated approach in order to guarantee high level of excellence. DESCRIPTORS:Newborn. Ambulances. Emergency medical services. Transport of patients. Qualitative research. Nursing. DIFICULDADES NO TRANSPORTE INTER-HOSPITALAR DE RECÉM-NASCIDO CRÍTICO REALIZADO PELAS EQUIPES DO SERVIÇO DE ATENDIMENTO MÓVEL DE URGÊNCIA RESUMOObjetivo: investigar as dificuldades das equipes do Serviço de Atendimento Móvel Urgência para a realização do transporte inter-hospitalar de recém-nascido crítico em ambulância.Método: estudo qualitativo, realizado com 17 profissionais de saúde, dentre médicos, enfermeiros e condutores de veículos atuantes no Serviço de Atendimento Móvel de Urgência de um município do interior do Ceará, no período de novembro a dezembro de 2014. Os dados foram produzidos por meio de entrevista semiestruturada, sendo as entrevistas gravadas. Os dados foram analisados por meio da análise temática de conteúdo.Resultados: as categorias apreendidas foram: escassez de materiais, de equipamentos e de veículos exclusivos para o transporte interhospitalar do recém-nascido; conhecimento, prática e treinamento deficientes para assistência ao recém-nascido crítico; e falha na comunicação entre os profissionais e dificuldade para a mobilidade da ambulância em via pública.Conclusão: as dificuldades mencionadas estão atreladas a todos os níveis de gestão e necessitam de um olhar diferenciado para que se garanta assistência de elevado nível de excelência. DESCRITORES: DIFICULTADES EN EL TRANSPORTE INTER-HOSPITALARIO DEL RECIEN NACIDO CRÍTICO REALIZADO POR LOS EQUIPOS DEL SERVICIOS DE ATENDIMIENTO MOVIL DE URGENCIA RESUMENObjetivo: investigar las dificultades de los equipos del Servicio de Atendimiento Móvil de Urgencia para la realización del transporte inter-hospitalaria del recién nacido critico en ambulancia.Método: investigación cualitativa, realizado con 17 profesionales de salud, dentro de médicos, enfermeros y conductores de vehículos actuantes en el servicio de Atención Móvil de Urgencias de un municipio del interior de Ceará, en el periodo de noviembre a diciembre de 2014. Los datos fueron producidos por medio de entrevistas semiestructura...

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“…172 The strength and success of this promotion is reflected in the way that the MI-PDSA approach has been applied across a range of contexts, and to a variety of issues. Many of these themes are of direct relevance to this study, including (i) the role of local champions in leading change; [182][183][184] (ii) the education of health-care professionals in evidence-based practice change; [185][186][187][188] (iii) the implementation of the World Health Organization Surgical Safety Checklist (WHOSSC); 169,[189][190][191] (iv) the development and implementation of anti-infective prescribing policies, [192][193][194] including those for correct hand hygiene; 195 and (v) the large-scale transformation of health-care services through a heightened emphasis on patient safety. Transforming Maternity Services -Reducing mortality and harm by improving the recognition and response to the acutely deteriorating woman -Reducing mortality and harm from venous thromboembolism in pregnancy and the postnatal period -Reducing preventable still birth in Wales Improving Primary and Community Care -Reducing chronic heart failure -Improving care for patients with atrial fibrillation -The primary care trigger tool -Improving medicines management -Improving care for patients with learning disabilities (Learning disabilities annual health check) -Reducing harm in dental care -Reducing harm from falls in the community Mental Health -Identifying depression in hospital settings -Improving dementia care -Prescribing of psychotropics -Eating disorder -First episode psychosis http://www.1000livesplus.wales.nhs.uk/programme-areas FIGURE 1 1000 Lives + national patient safety programme areas.…”

Section: Lives + National Programme In Nhs Walesmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Making Good Better: Implementing a Standardized Handoff in Pediatric Transport

Cited by 41 publications

References 9 publications

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

Dificuldades No Transporte Inter-Hospitalar De Recém-Nascido Crítico Realizado Pelas Equipes Do Serviço De Atendimento Móvel De Urgência

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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